The Brave New World of Anaesthesia

Encompassing anesthesia, intensive care medicine, critical emergency medicine, and pain medicine

Dr. Vasanthi Vidyasagaran*

Department of Anaesthesiology, Kauvery Hospital, Chennai

It is festival season all around the world and as people rejoice, we have yet another event to celebrate “The World Anaesthesia Day or The Ether Day” which falls on 16th of October. This is a day which should be celebrated by not just the anaesthesiologist but by the surgeons and the whole of the human race, as it marks the beginning of a pain free era in surgery.

Way back in 1846, W.T.G Morton, a dentist by profession did a public demonstration of the Ether Anaesthesia in Massachusetts General Hospital, Boston. A patient with the mandibular tumour was operated upon in full public view under General Anaesthesia. The patient was not just pain free but alive and woke up at the end of the surgery, which was not very common those days. It used to be a situation of “Operation was successful but the patient is no more”

We have come long way from there and if we as anaesthesiologists were to still administer “Open drop ether surgeons cannot perform open heart surgery”. In addition to the improvement in surgical techniques and technology it is an irrefutable fact that advances in the field of Anaesthesia have contributed to a great extent for a successful surgical outcome, especially in laparoscopy, oncosurgery, cardiac, neuro and transplant surgeries.

We now don several caps, each of them contributes to the wellbeing of our patients. Now we are also Peri-operative Physicians as we understand the requirement of a surgical patient in the pre, intra and the post operative period. Opinions from the respective medical speciality are important for the surgical patient with co morbid conditions. But the ultimate responsibility for decision making in the immediate post-op period falls on the anaesthesiologist, in consultation and collaboration with the surgical colleagues, the main intent being safe outcomes for the patient.

The world applauded the work of the anaesthesiologist during the Covid pandemic; their work included management of the patient in the ICU, organizing medical oxygen supplies, and on the whole planning, coordinating and executing in a structured manner to give the best possible care to the patient. This was done with a lot of effort and commitment by anaesthesiologists world over, risking their own lives.

Skilful Administration and efficient Disaster Management are the strengths of the Anaesthesiologist. Pain and palliative care unit, caring for a patient in an Emergency Room, training and teaching BLS, ACLS are other domains of an Anaesthesiologist.

The Anaesthesiologist plays a key role in saving lives whether inside or outside the hospital. The heroic and successful work of Dr. Richard Harris, an anaesthesiologist by profession who, along with other several rescuers,saved the teenaged football players from a flooded cave in Thailand will he etched in our memories forever.

In recent times, the onus on the anaesthesiologist is not only to provide safe anaesthesia to patients but leave behind a safe environment!

There is enough evidence to prove that the impact of carbon foot print is high from hospitals, specifically from operation theatres, which in turn can contribute to the depletion of the ozone layer and thus global warming. Some of the examples of carbon foot print are volatile anaesthetic agents (Desflurane, Nitrous Oxide), surgical wastes, plastics, disposables, heating, ventilation, lighting and air conditioning. Anaesthesiologist can contribute to a great extent by adapting a “Green OT Concept”. This massive pollution and harm to the environment can be minimized by using Reduce, Reuse, Recycle strategy whenever possible. Use of newer techniques such as Low Flow Anaesthesia (LFA) if inhalation agents are required, Total Intravenous Anaesthesia (TIVA), without any inhalation agent, using Regional Anaesthesia techniques, whenever possible or some of the practical methods where the anaesthesiologist can play a major role.

In recent times Artificial Intelligence (AI) has been adapted in all medical fields including anaesthesiology. Depth of anaesthesia monitoring, Control of anaesthesia, Event and risk prediction, Ultrasound guidance, Pain management, and Operating room logistics are some of the situations where AI can be used successfully.

Robots can be made to anaesthetize a patient but anaesthesiology always requires a human in charge to make it beneficial and safe to the patient and the health care provider.

Socioeconomic impact of robots and AI on human work force is huge but whether a so called third world country can adapt it into routine practice is questionable due to the wide disparity in the quality of the health care provided in different parts of the country.

Even with the advent of AI and robotics, as long as there is the human race, Anaesthesia as a speciality shall not become redundant at any time in the future. “World Anaesthesia Day” shall be celebrated in all its glory with great pride and greater modesty on every October 16th, reminding us to thank the pioneers who developed this science to make sure that we undergo and emerge safely from surgery and without pain. Anaesthesiologists of the world continue to make sure that we can be free from chronic pain as well.

The unique speciality of anaesthesia hovers over and guards the lives of patients all over the world, in a kind, quiet and efficient way.

Dr. Vasanthi Vidyasagaran

Anesthesiologist

The Brave New World of Anaesthesia